title: Clinical, radiographic characteristics and immunomodulating changes in neuromyelitis optica with extensive brain lesions.
abstract: BACKGROUND
  Neuromyelitis optica (NMO) shows various brain magnetic resonance imaging (MRI) abnormalities with recurrent central nervous system (CNS) attacks, although predominantly affecting the spinal cord and optic nerve. However, NMO with extensive involvement of the brain has infrequently been studied. We investigated the clinical, radiographic features and immunomodulating changes of NMO patients with extensive brain lesions (EBLs) in China.
  
  
  METHODS
  NMO patients (including 16 NMO patients with EBLs and 53 NMO patients without EBLs) hospitalized during January 2006 and February 2010 were recruited and analyzed retrospectively. Data of clinical characteristics, magnetic resonance imaging (MRI) features, laboratory abnormalities, treatment details and outcomes were analyzed. All the patients received the follow-up visits for two years.
  
  
  RESULTS
  EBLs in NMO were classified into four categories according to their respective MRI characteristics: 1) Tumefactive-like lesions (n=4, 25%); 2) Acute disseminated encephalomyelitis (ADEM)-like lesions (n=6, 37.5%); 3) Multiple sclerosis (MS)-like lesions (n=5, 31.25%); 4) Posterior reversible encephalopathy syndrome (PRES)-like lesions (n=1, 6.25%). NMO patients with EBLs had higher rates of encephalopathy symptoms (37.5% vs. 5.6%, p = 0.004), homonymous hemianopia (18.8% vs. 0%, p = 0.011) and AQP4 seropositivity (100% vs. 69.8%, p = 0.008) than NMO patients without EBLs (NEBLs). Immunomodulating changes (including the levels of C3, C4, ESR and CRP) were significantly higher in patients with EBLs than those without EBLs. The relapse times in EBLs during the follow-up period were more frequent than those happened in NEBLs (1.88 ± 0.30 vs. 1.23 ± 0.14, p = 0.04). The EDSS scores in EBLs patients were also much higher than those in NEBLs throughout all the whole visits of follow-up.
  
  
  CONCLUSIONS
  The presence of EBLs in NMO may indicate a higher diseases activity and portend a worse prognosis. CRP is a useful marker in monitoring diseases activity. Systemic inflammation may be crucial to the formation of EBLs in NMO.
authors.affiliation: Multiple sclerosis center, Department of Neurology, the Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, Guangdong 510630, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Cheng
authors.forename: Ying
authors.initials: Y
authors.lastname: Jiang
authors.forename: Xiaohong
authors.initials: X
authors.lastname: Chen
authors.forename: Yongqiang
authors.initials: Y
authors.lastname: Dai
authors.forename: Zhuang
authors.initials: Z
authors.lastname: Kang
authors.forename: Zhengqi
authors.initials: Z
authors.lastname: Lu
authors.forename: Fuhua
authors.initials: F
authors.lastname: Peng
authors.forename: Xueqiang
authors.initials: X
authors.lastname: Hu
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D051401:Aquaporin 4 / Q000097:blood; D001921:Brain / Q000473:pathology*; D001930:Brain Injuries / Q000150:complications / Q000276:immunology / Q000473:pathology; D002097:C-Reactive Protein / Q000378:metabolism; D016009:Chi-Square Distribution; D003165:Complement System Proteins / Q000378:metabolism; D056324:Diffusion Tensor Imaging; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D009471:Neuromyelitis Optica / Q000150:complications / Q000276:immunology / Q000473:pathology; D043025:Oligoclonal Bands / Q000378:metabolism*; D012189:Retrospective Studies
chemical_list: C496030:AQP4 protein, human; D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D051401:Aquaporin 4; D043025:Oligoclonal Bands; D003165:Complement System Proteins; D002097:C-Reactive Protein; D008775:Methylprednisolone